Changes in the Use and Costs of Diagnostic Imaging Among Medicare Beneficiaries With Cancer, 1999-2006
Changes in the Use and Costs of Diagnostic Imaging Among Medicare Beneficiaries With Cancer, 1999-2006
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DOI：
10.1001/jama.2010.460
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发表时间：
2010-04-28
影响因子：
120.7
通讯作者：
Schulman, Kevin A.
中科院分区：
文献类型：
--
作者：
Dinan, Michaela A.;Curtis, Lesley H.;Schulman, Kevin A.
背景新兴技术、不断变化的诊断和治疗模式以及医疗保险报销的变化正在促使成像在癌症中的使用不断增加。成像是 Medicare 中增长最快的费用，但尚未在癌症受益人中进行检查。目的 研究成像使用的变化以及这些变化如何影响癌症护理的总体成本。设计、设置和患者 对 1999 年至 2008 年美国医疗保险和医疗补助服务中心的具有全国代表性的 5% 索赔样本进行分析。患者是患有乳腺癌、结直肠癌、癌症的 Medicare 受益人。白血病、肺癌、非霍奇金淋巴瘤或前列腺癌。主要结果指标按方式、年份和癌症类型划分的影像学使用和费用。结果 1999 年至 2006 年，乳腺癌、结直肠癌、白血病、肺癌、非霍奇金淋巴瘤和前列腺癌的发病病例为 100 954 例。所有癌症类型的正电子影像学使用量年均显着增加发射断层扫描（35.9%-53.6%）、骨密度研究（6.3%-20.0%）、超声心动图（5.0%-7.8%）、磁共振成像（4.4%-11.5%）和超声检查（0.7%-7.4%）。传统的射线照相率下降或保持不变。截至 2006 年，肺癌受益人和淋巴瘤受益人的总体成像费用最高，在诊断后 2 年内，每位受益人平均花费超过 3000 美元。到 2005 年，三分之一的乳腺癌受益人接受了骨扫描，一半的肺癌或淋巴瘤受益人接受了正电子发射断层扫描。每个受益人的平均 2 年成像费用的增长率高于所有癌症类型的每个受益人的平均总费用的增长率。 结论 从 1999 年到 2006 年，患有癌症的 Medicare 受益人的成像费用有所增加，超过了患有癌症的 Medicare 受益人的总费用的增长率。贾马。 2010;303(16):1625-1631 www.jama.com
Context Emerging technologies, changing diagnostic and treatment patterns, and changes in Medicare reimbursement are contributing to increasing use of imaging in cancer. Imaging is the fastest growing expense for Medicare but has not been examined among beneficiaries with cancer.Objective To examine changes in the use of imaging and how those changes contribute to the overall cost of cancer care.Design, Setting, and Patients Analysis of a nationally representative 5% sample of claims from the US Centers for Medicare & Medicaid Services from 1999 through 2008. Patients were Medicare beneficiaries with incident breast cancer, colorectal cancer, leukemia, lung cancer, non-Hodgkin lymphoma, or prostate cancer.Main Outcome Measures Use and cost of imaging by modality, year, and cancer type.Results There were 100 954 incident cases of breast cancer, colorectal cancer, leukemia, lung cancer, non-Hodgkin lymphoma, and prostate cancer from 1999 through 2006. Significant mean annual increases in imaging use occurred among all cancer types for positron emission tomography (35.9%-53.6%), bone density studies (6.3%-20.0%), echocardiograms (5.0%-7.8%), magnetic resonance imaging (4.4%-11.5%), and ultrasound (0.7%-7.4%). Conventional radiograph rates decreased or stayed the same. As of 2006, beneficiaries with lung cancer and beneficiaries with lymphoma incurred the largest overall imaging costs, exceeding a mean of $3000 per beneficiary within 2 years of diagnosis. By 2005, one-third of beneficiaries with breast cancer underwent bone scans and half of beneficiaries with lung cancer or lymphoma underwent positron emission tomography scans. Mean 2-year imaging costs per beneficiary increased at a rate greater than the increase in mean total costs per beneficiary for all cancer types.Conclusion Imaging costs among Medicare beneficiaries with cancer increased from 1999 through 2006, outpacing the rate of increase in total costs among Medicare beneficiaries with cancer. JAMA. 2010;303(16):1625-1631 www.jama.com